Y Zhong

Dual resolution cone beam breast CT: A feasibility study

PURPOSE In this study, the authors investigated the feasibility of a dual resolution volume-of-interest (VOI) cone beam breast CT technique and compared two implementation approaches in terms of dose saving and scatter reduction. METHODS With this technique, a lead VOI mask with an opening is inserted between the x-ray source and the breast to deliver x-ray exposure to the VOI while blocking x rays outside the VOI. A CCD detector is used to collect the high resolution projection data of the VOI. Low resolution cone beam CT (CBCT) images of the entire breast, acquired with a flat panel (FP) detector, were used to calculate the projection data outside the VOI with the ray-tracing reprojection method. The Feldkamp-Davis-Kress filtered backprojection algorithm was used to reconstruct the dual resolution 3D images. Breast phantoms with 180 microm and smaller microcalcifications (MCs) were imaged with both FP and FP-CCD dual resolution CBCT systems, respectively. Two approaches of implementing the dual resolution technique, breast-centered approach and VOI-centered approach, were investigated and evaluated for dose saving and scatter reduction with Monte Carlo simulation using a GEANT4 package. RESULTS The results showed that the breast-centered approach saved more breast absorbed dose than did VOI-centered approach with similar scatter reduction. The MCs in fatty breast phantom, which were invisible with FP CBCT scan, became visible with the FP-CCD dual resolution CBCT scan. CONCLUSIONS These results indicate potential improvement of the image quality inside the VOI with reduced breast dose both inside and outside the VOI.

High resolution dual detector volume-of-interest cone beam breast CT––Demonstration with a bench top system

PURPOSE In this study, we used a small field high resolution detector in conjunction with a full field flat panel detector to implement and investigate the dual detector volume-of-interest (VOI) cone beam breast computed tomography (CBCT) technique on a bench-top system. The potential of using this technique to image small calcifications without increasing the overall dose to the breast was demonstrated. Significant reduction of scatter components in the high resolution projection image data of the VOI was also shown. METHODS With the regular flat panel based CBCT technique, exposures were made at 80 kVp to generate an air kerma of 6 mGys at the isocenter. With the dual detector VOI CBCT technique, a high resolution small field CMOS detector was used to scan a cylindrical VOI (2.5 cm in diameter and height, 4.5 cm off-center) with collimated x-rays at four times of regular exposure level. A flat panel detector was used for full field scan with low x-ray exposures at half of the regular exposure level. The low exposure full field image data were used to fill in the truncated space in the VOI scan data and generate a complete projection image set. The Feldkamp-Davis-Kress (FDK) filtered backprojection algorithm was used to reconstruct high resolution images for the VOI. Two scanning techniques, one breast centered and the other VOI centered, were implemented and investigated. Paraffin cylinders with embedded thin aluminum (Al) wires were imaged and used in conjunction with optically stimulated luminescence (OSL) dose measurements to demonstrate the ability of this technique to image small calcifications without increasing the mean glandular dose (MGD). RESULTS Using exposures that produce an air kerma of 6 mGys at the isocenter, the regular CBCT technique was able to resolve the cross-sections of Al wires as thin as 254 μm in diameter in the phantom. For the specific VOI studied, by increasing the exposure level by a factor of 4 for the VOI scan and reducing the exposure level by a factor of 2 for the full filed scan, the dual-detector CBCT technique was able to resolve the cross-sections of Al wires as thin as 152 μm in diameter. The CNR evaluated for the entire Al wire cross-section was found to be improved from 5.5 in regular CBCT to 14.4 and 16.8 with the breast centered and VOI centered scanning techniques, respectively. Even inside VOI center, the VOI scan resulted in significant dose saving with the dose reduced by a factor of 1.6 at the VOI center. Dose saving outside the VOI was substantial with the dose reduced by a factor of 7.3 and 7.8 at the breast center for the breast centered and VOI centered scans, respectively, when compared to full field scan at the same exposure level. The differences between the two dual detector techniques in terms of dose saving and scatter reduction were small with VOI scan at 4× exposure level and full field scan at 0.5 × exposure level. The MGDs were only 94% of that from the regular CBCT scan. CONCLUSIONS For the specific VOI studied, the dual detector VOI CBCT technique has the potential to provide high quality images inside the VOI with MGD similar to or even lower than that of full field breast CBCT. It was also found that our results were compromised by the use of inadequate detectors for the VOI scan. An appropriately selected detector would better optimize the image quality improvement that can be achieved with the VOI CBCT technique.

Radiation doses in cone-beam breast computed tomography: a Monte Carlo simulation study.

PURPOSE In this article, we describe a method to estimate the spatial dose variation, average dose and mean glandular dose (MGD) for a real breast using Monte Carlo simulation based on cone beam breast computed tomography (CBBCT) images. We present and discuss the dose estimation results for 19 mastectomy breast specimens, 4 homogeneous breast models, 6 ellipsoidal phantoms, and 6 cylindrical phantoms. METHODS To validate the Monte Carlo method for dose estimation in CBBCT, we compared the Monte Carlo dose estimates with the thermoluminescent dosimeter measurements at various radial positions in two polycarbonate cylinders (11- and 15-cm in diameter). Cone-beam computed tomography (CBCT) images of 19 mastectomy breast specimens, obtained with a bench-top experimental scanner, were segmented and used to construct 19 structured breast models. Monte Carlo simulation of CBBCT with these models was performed and used to estimate the point doses, average doses, and mean glandular doses for unit open air exposure at the iso-center. Mass based glandularity values were computed and used to investigate their effects on the average doses as well as the mean glandular doses. Average doses for 4 homogeneous breast models were estimated and compared to those of the corresponding structured breast models to investigate the effect of tissue structures. Average doses for ellipsoidal and cylindrical digital phantoms of identical diameter and height were also estimated for various glandularity values and compared with those for the structured breast models. RESULTS The absorbed dose maps for structured breast models show that doses in the glandular tissue were higher than those in the nearby adipose tissue. Estimated average doses for the homogeneous breast models were almost identical to those for the structured breast models (p=1). Normalized average doses estimated for the ellipsoidal phantoms were similar to those for the structured breast models (root mean square (rms) percentage difference = 1.7%; p = 0.01), whereas those for the cylindrical phantoms were significantly lower (rms percentage difference = 7.7%; p < 0.01). Normalized MGDs were found to decrease with increasing glandularity. CONCLUSIONS Our results indicate that it is sufficient to use homogeneous breast models derived from CBCT generated structured breast models to estimate the average dose. This investigation also shows that ellipsoidal digital phantoms of similar dimensions (diameter and height) and glandularity to actual breasts may be used to represent a real breast to estimate the average breast dose with Monte Carlo simulation. We have also successfully demonstrated the use of structured breast models to estimate the true MGDs and shown that the normalized MGDs decreased with the glandularity as previously reported by other researchers for CBBCT or mammography.

Reduction in x-ray scatter and radiation dose for volume-of-interest (VOI) cone-beam breast CT—a phantom study

With volume-of-interest (VOI) cone-beam computed tomography (CBCT) imaging, one set of projection images are acquired with the VOI collimator at a regular or high exposure level and the second set of projection images are acquired without the collimator at a reduced exposure level. The high exposure VOI scan data inside the VOI and the low exposure full-field scan data outside the VOI are then combined together to generate composite projection images for image reconstruction. To investigate and quantify scatter reduction, dose saving and image quality improvement in VOI CBCT imaging, a flat panel detector-based bench-top experimental CBCT system was built to measure the dose, the scatter-to-primary ratio (SPR), the image contrast, noise level, the contrast-to-noise ratio (CNR) and the figure of merit (FOM) in the CBCT reconstructed images for two polycarbonate cylinders simulating the small and the large phantoms. The results showed that, compared to the full field CBCT technique, radiation doses for the VOI CBCT technique were reduced by a factor of 1.20 and 1.36 for the small and the large phantoms at the phantom center, respectively, and from 2.7 to 3.0 on the edge of the phantom, respectively. Inside the VOI, the SPRs were substantially reduced by a factor of 6.6 and 10.3 for the small and the large phantoms, the contrast signals were improved by a factor of 1.35 and 1.8, and the noise levels were increased by a factor of 1.27 and 1.6, respectively. As a result, the CNRs were improved by a factor of 1.06 and 1.13 for the small and the large phantoms and the FOM improved by a factor of 1.4 and 1.7, respectively.

Cone beam breast CT with a high pitch (75 μm), thick (500 μm) scintillator CMOS flat panel detector: Visibility of simulated microcalcifications

PURPOSE To measure and investigate the improvement of microcalcification (MC) visibility in cone beam breast CT with a high pitch (75 μm), thick (500 μm) scintillator CMOS/CsI flat panel detector (Dexela 2923, Perkin Elmer). METHODS Aluminum wires and calcium carbonate grains of various sizes were embedded in a paraffin cylinder to simulate imaging of calcifications in a breast. Phantoms were imaged with a benchtop experimental cone beam CT system at various exposure levels. In addition to the Dexela detector, a high pitch (50 μm), thin (150 μm) scintillator CMOS/CsI flat panel detector (C7921CA-09, Hamamatsu Corporation, Hamamatsu City, Japan) and a widely used low pitch (194 μm), thick (600 μm) scintillator aSi/CsI flat panel detector (PaxScan 4030CB, Varian Medical Systems) were also used in scanning for comparison. The images were independently reviewed by six readers (imaging physicists). The MC visibility was quantified as the fraction of visible MCs and measured as a function of the estimated mean glandular dose (MGD) level for various MC sizes and detectors. The modulation transfer functions (MTFs) and detective quantum efficiencies (DQEs) were also measured and compared for the three detectors used. RESULTS The authors have demonstrated that the use of a high pitch (75 μm) CMOS detector coupled with a thick (500 μm) CsI scintillator helped make the smaller 150-160, 160-180, and 180-200 μm MC groups more visible at MGDs up to 10.8, 9, and 10.8 mGy, respectively. It also made the larger 200-212 and 212-224 μm MC groups more visible at MGDs up to 7.2 mGy. No performance improvement was observed for 224-250 μm or larger size groups. With the higher spatial resolution of the Dexela detector based system, the apparent dimensions and shapes of MCs were more accurately rendered. The results show that with the aforementioned detector, a 73% visibility could be achieved in imaging 160-180 μm MCs as compared to 28% visibility achieved by the low pitch (194 μm) aSi/CsI flat panel detector. The measurements confirm that the Hamamatsu detector has the highest MTF, followed by the Dexel detector, and then the Varian detector. However, the Dexela detector, with its thick (500 μm) CsI scintillator and low noise level, has the highest DQE at all frequencies, followed by the Varian detector, and then the Hamamatsu detector. The findings on the MC visibility correlated well with the differences in MTFs, noise power spectra, and DQEs measured for these three detectors. CONCLUSIONS The authors have demonstrated that the use of the CMOS type Dexela detector with its high pitch (75 μm) and thick (500 μm) CsI scintillator could help improve the MC visibility. However, the improvement depended on the exposure level and the MC size. For imaging larger MCs or scanning at high exposure levels, there was little advantage in using the Dexela detector as compared to the aSi type Varian detector. These findings correlate well with the higher measured DQEs of the Dexela detector, especially at higher frequencies.

Breast density measurement: 3D cone beam computed tomography (CBCT) images versus 2D digital mammograms

Breast density has been recognized as one of the major risk factors for breast cancer. However, breast density is currently estimated using mammograms which are intrinsically 2D in nature and cannot accurately represent the real breast anatomy. In this study, a novel technique for measuring breast density based on the segmentation of 3D cone beam CT (CBCT) images was developed and the results were compared to those obtained from 2D digital mammograms. 16 mastectomy breast specimens were imaged with a bench top flat-panel based CBCT system. The reconstructed 3D CT images were corrected for the cupping artifacts and then filtered to reduce the noise level, followed by using threshold-based segmentation to separate the dense tissue from the adipose tissue. For each breast specimen, volumes of the dense tissue structures and the entire breast were computed and used to calculate the volumetric breast density. BI-RADS categories were derived from the measured breast densities and compared with those estimated from conventional digital mammograms. The results show that in 10 of 16 cases the BI-RADS categories derived from the CBCT images were lower than those derived from the mammograms by one category. Thus, breasts considered as dense in mammographic examinations may not be considered as dense with the CBCT images. This result indicates that the relation between breast cancer risk and true (volumetric) breast density needs to be further investigated.

A dual-view digital tomosynthesis imaging technique for improved chest imaging

PURPOSE Digital tomosynthesis (DTS) has been shown to be useful for reducing the overlapping of abnormalities with anatomical structures at various depth levels along the posterior-anterior (PA) direction in chest radiography. However, DTS provides crude three-dimensional (3D) images that have poor resolution in the lateral view and can only be displayed with reasonable quality in the PA view. Furthermore, the spillover of high-contrast objects from off-fulcrum planes generates artifacts that may impede the diagnostic use of the DTS images. In this paper, the authors describe and demonstrate the use of a dual-view DTS technique to improve the accuracy of the reconstructed volume image data for more accurate rendition of the anatomy and slice images with improved resolution and reduced artifacts, thus allowing the 3D image data to be viewed in views other than the PA view. METHODS With the dual-view DTS technique, limited angle scans are performed and projection images are acquired in two orthogonal views: PA and lateral. The dual-view projection data are used together to reconstruct 3D images using the maximum likelihood expectation maximization iterative algorithm. In this study, projection images were simulated or experimentally acquired over 360° using the scanning geometry for cone beam computed tomography (CBCT). While all projections were used to reconstruct CBCT images, selected projections were extracted and used to reconstruct single- and dual-view DTS images for comparison with the CBCT images. For realistic demonstration and comparison, a digital chest phantom derived from clinical CT images was used for the simulation study. An anthropomorphic chest phantom was imaged for the experimental study. The resultant dual-view DTS images were visually compared with the single-view DTS images and CBCT images for the presence of image artifacts and accuracy of CT numbers and anatomy and quantitatively compared with root-mean-square-deviation (RMSD) values computed using the digital chest phantom or the CBCT images as the reference in the simulation and experimental study, respectively. High-contrast wires with vertical, oblique, and horizontal orientations in a PA view plane were also imaged to investigate the spatial resolutions and how the wire signals spread in the PA view and lateral view slice images. RESULTS Both the digital phantom images (simulated) and the anthropomorphic phantom images (experimentally generated) demonstrated that the dual-view DTS technique resulted in improved spatial resolution in the depth (PA) direction, more accurate representation of the anatomy, and significantly reduced artifacts. The RMSD values corroborate well with visual observations with substantially lower RMSD values measured for the dual-view DTS images as compared to those measured for the single-view DTS images. The imaging experiment with the high-contrast wires shows that while the vertical and oblique wires could be resolved in the lateral view in both single- and dual-view DTS images, the horizontal wire could only be resolved in the dual-view DTS images. This indicates that with single-view DTS, the wire signals spread liberally to off-fulcrum planes and generated wire shadow there. CONCLUSIONS The authors have demonstrated both visually and quantitatively that the dual-view DTS technique can be used to achieve more accurate rendition of the anatomy and to obtain slice images with improved resolution and reduced artifacts as compared to the single-view DTS technique, thus allowing the 3D image data to be viewed in views other than the PA view. These advantages could make the dual-view DTS technique useful in situations where better separation of the objects-of-interest from the off-fulcrum structures or more accurate 3D rendition of the anatomy are required while a regular CT examination is undesirable due to radiation dose considerations.

Scan equalization digital radiography (SEDR) implemented with an amorphous Selenium flat-panel detector: initial experience

It is well recognized in projection radiography that low-contrast detectability suffers in heavily attenuating regions due to excessively low x-ray fluence to the image receptor and higher noise levels. Exposure equalization can improve image quality by increasing the x-ray exposure to heavily attenuating regions, resulting in a more uniform distribution of exposure to the detector. Image quality is also expected to be improved by using the slot-scan geometry to reject scattered radiation effectively without degrading primary x-rays. This paper describes the design of a prototype scan equalization digital radiography (SEDR) system implemented with an amorphous silicon (a-Si) thin-film transistor (TFT) array-based flat-panel detector. With this system, slot-scan geometry with alternate line erasure and readout (ALER) technique was used to achieve scatter rejection. A seven-segment beam height modulator assembly was mounted onto the fore collimator to regulate exposure regionally for chest radiography. The beam modulator assembly, consisting of micro linear motors, lead screw cartridge with lead (Pb) beam blockers attached, position feedback sensors and motor driver circuitry, has been tested and found to have an acceptable response for exposure equalization in chest radiography. An anthropomorphic chest phantom was imaged in the posterior-anterior (PA) view under clinical conditions. Scatter component, primary x-rays, scatter-to-primary ratios (SPRs) and primary signal-to-noise ratios (PSNRs) were measured in the SEDR images to evaluate the rejection and redistribution of scattered radiation, and compared with those for conventional full-field imaging with and without anti-scatter grid methods. SPR reduction ratios (SPRRRs, defined as the differences between the non-grid full-field SPRs and the reduced SPRs divided by the former) yielded approximately 59% for the full-field imaging with grid and 82% for the SEDR technique in the lungs, and 77% for the full-field imaging with grid and 95% for the SEDR technique in the subdiaphragm. The SEDR technique demonstrated a substantial improvement in PSNRs over the anti-scatter grid technique. The improvements of PSNRs varied with the regions and are more pronounced in heavily attenuating regions.

A new CT reconstruction technique using adaptive deformation recovery and intensity correction (ADRIC)

Purpose Sequential same‐patient CT images may involve deformation‐induced and non‐deformation‐induced voxel intensity changes. An adaptive deformation recovery and intensity correction (ADRIC) technique was developed to improve the CT reconstruction accuracy, and to separate deformation from non‐deformation‐induced voxel intensity changes between sequential CT images. Materials and methods ADRIC views the new CT volume as a deformation of a prior high‐quality CT volume, but with additional non‐deformation‐induced voxel intensity changes. ADRIC first applies the 2D‐3D deformation technique to recover the deformation field between the prior CT volume and the new, to‐be‐reconstructed CT volume. Using the deformation‐recovered new CT volume, ADRIC further corrects the non‐deformation‐induced voxel intensity changes with an updated algebraic reconstruction technique (“ART‐dTV”). The resulting intensity‐corrected new CT volume is subsequently fed back into the 2D‐3D deformation process to further correct the residual deformation errors, which forms an iterative loop. By ADRIC, the deformation field and the non‐deformation voxel intensity corrections are optimized separately and alternately to reconstruct the final CT. CT myocardial perfusion imaging scenarios were employed to evaluate the efficacy of ADRIC, using both simulated data of the extended‐cardiac‐torso (XCAT) digital phantom and experimentally acquired porcine data. The reconstruction accuracy of the ADRIC technique was compared to the technique using ART‐dTV alone, and to the technique using 2D‐3D deformation alone. The relative error metric and the universal quality index metric are calculated between the images for quantitative analysis. The relative error is defined as the square root of the sum of squared voxel intensity differences between the reconstructed volume and the “ground‐truth” volume, normalized by the square root of the sum of squared “ground‐truth” voxel intensities. In addition to the XCAT and porcine studies, a physical lung phantom measurement study was also conducted. Water‐filled balloons with various shapes/volumes and concentrations of iodinated contrasts were put inside the phantom to simulate both deformations and non‐deformation‐induced intensity changes for ADRIC reconstruction. The ADRIC‐solved deformations and intensity changes from limited‐view projections were compared to those of the “gold‐standard” volumes reconstructed from fully sampled projections. Results For the XCAT simulation study, the relative errors of the reconstructed CT volume by the 2D‐3D deformation technique, the ART‐dTV technique, and the ADRIC technique were 14.64%, 19.21%, and 11.90% respectively, by using 20 projections for reconstruction. Using 60 projections for reconstruction reduced the relative errors to 12.33%, 11.04%, and 7.92% for the three techniques, respectively. For the porcine study, the corresponding results were 13.61%, 8.78%, and 6.80% by using 20 projections; and 12.14%, 6.91%, and 5.29% by using 60 projections. The ADRIC technique also demonstrated robustness to varying projection exposure levels. For the physical phantom study, the average DICE coefficient between the initial prior balloon volume and the new “gold‐standard” balloon volumes was 0.460. ADRIC reconstruction by 21 projections increased the average DICE coefficient to 0.954. Conclusion The ADRIC technique outperformed both the 2D‐3D deformation technique and the ART‐dTV technique in reconstruction accuracy. The alternately solved deformation field and non‐deformation voxel intensity corrections can benefit multiple clinical applications, including tumor tracking, radiotherapy dose accumulation, and treatment outcome analysis.

A general method for cupping artifact correction of cone-beam breast computed tomography images

PurposeCone-beam breast computed tomography (CBBCT), a promising breast cancer diagnostic technique, has been under investigation for the past decade. However, owing to scattered radiation and beam hardening, CT numbers are not uniform on CBBCT images. This is known as cupping artifact, and it presents an obstacle for threshold-based volume segmentation. In this study, we proposed a general post-reconstruction method for cupping artifact correction.MethodsThere were four steps in the proposed method. First, three types of local region histogram peaks were calculated: adipose peaks with low CT numbers, glandular peaks with high CT numbers, and unidentified peaks. Second, a linear discriminant analysis classifier, which was trained by identified adipose and glandular peaks, was employed to identify the unidentified peaks as adipose or glandular peaks. Third, adipose background signal profile was fitted according to the adipose peaks using the least squares method. Finally, the adipose background signal profile was subtracted from original image to obtain cupping corrected imageResultsIn experimental study, standard deviation of adipose tissue CT numbers was obviously reduced and the CT numbers were more uniform after cupping correction by proposed method; in simulation study, root-mean-square errors were significantly reduced for both symmetric and asymmetric cupping artifacts, indicating that the proposed method was effective to both artifacts.ConclusionsA general method without a circularly symmetric assumption was proposed to correct cupping artifacts in CBBCT images for breast. It may be properly applied to images of real patient breasts with natural pendent geometry.